Monoclonal antibody production in murine ascites. II. Production characteristics

OBJECTIVE: To characterize monoclonal antibody production parameters of five hybridoma cell lines in murine ascites for correlation with clinicopathologic changes in mice. METHODS: Five hybridoma cell lines were grown in groups of 20 mice. Fourteen days prior to inoculation with 10(6) hybridoma cells, mice were primed with 0.5 ml of pristane given intraperitoneally. Ascites fluid was collected a maximum of three times by abdominal paracentesis; volume was measured and antibody concentration was determined by ELISA for each sample. RESULTS: Trends differed among cell lines when comparing ascites volumes and antibody concentrations over time from the first to the third tap. Antibody production was greatest at tap 1 for Groups 2B11 and 2C6D9; tap 2 for Group 3C9; and tap 3 for Groups RMK and 3D6. Total antibody production ranged from 422.90 to 996.64 mg; total ascites fluid volume ranged from 74.2 to 115.7 ml; and mean antibody concentration for taps 1, 2, and 3 ranged from 2.50 to 15.03 mg/ml among cell lines. CONCLUSION: Production characteristics were significantly different among hybridoma cell lines. Determination of production characteristics of hybridomas and correlation with clinicopathologic changes in mice may be valuable in making recommendations for managing mice with ascites.     

Comparison of spontaneous ascites filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites.

OBJECTIVE--To compare the effectiveness and safety of spontaneous ascites filtration and reinfusion and total paracentesis plus intravenous albumin infusion in cirrhotic patients with tense ascites. DESIGN--Randomised trial of the two treatments. SETTING--Teaching hospital and district general hospital in Milan. PATIENTS--45 consecutive cirrhotic patients with recurrent tense ascites and urinary sodium excretion rate less than 20 mmol/day. 35 fulfilled admission criteria and completed the study. 17 received spontaneous ascites filtration and 18 paracentesis plus albumin infusion. MAIN OUTCOME MEASURES--Body weight; urinary volume; serum and urinary electrolyte, serum fibrinogen, and plasma aldosterone concentrations; and plasma renin activity before the procedure and 24 hours and eight days afterwards. RESULTS--Both procedures were effective in all patients. Weight decreased in both groups and showed no substantial increase after eight days. In patients receiving ascites filtration, values decreased significantly (p less than 0.01) after 24 hours for platelet count (mean relative change 0.92; 99% confidence interval 0.86 to 0.98) and serum fibrinogen concentration (0.92; 0.88 to 0.98) but returned to pretreatment values after eight days; no laboratory and clinical signs of disseminated intravascular coagulation were noted. Three patients in this group had fever, which receded spontaneously. One patient in each group had dilutional hyponatraemia. CONCLUSIONS--Spontaneous ascites filtration and reinfusion is an effective treatment for tense ascites. Reinfusion of the patient''s concentrated proteins provides savings without compromising safety.     

Cytologic diagnosis of peripheral T-cell lymphoma manifesting as ascites. A case report

BACKGROUND: Patients with malignant lymphoma seldom present with effusions without a known history of malignancy. Because of this, initial diagnosis of malignant lymphoma by effusion cytology is uncommon, with few reported cases. CASE: A 75-year-old male presented with fatigue, decreased appetite and progressively increasing abdominal girth over five weeks. Cytologic examination of ascitic fluid obtained by paracentesis revealed non-Hodgkin's lymphoma with a T-cell phenotype, confirmed by immunophenotypic and molecular studies. Approximately one week later, histologic examination of liver and bone marrow revealed involvement by lymphoma, demonstrating immunophenotypic and molecular profiles identical to those obtained from neoplastic lymphocytes recovered from the ascites fluid. CONCLUSION: This case demonstrates a rare presentation of peripheral T-cell lymphoma, clinically manifesting as ascites. In cases such as ours, where the effusion consists predominantly of small to intermediate-sized lymphocytes, distinguishing lymphoma from reactive lymphocytosis may be difficult. This case not only demonstrates the value of effusion cytology for lymphoma diagnosis but also illustrates how the use of various immunophenotypic and molecular techniques may assist the pathologist in properly diagnosing these difficult cases.     

Mirror agnosia.

Normal people rarely confuse the mirror image of an object with a real object so long as they realize they are looking into a mirror. We report a new neurological sign, ''mirror agnosia'', following right parietal lesions in which this ability is severely compromised. We studied four right hemisphere stroke patients who had left visual field ''neglect''. i.e. they were indifferent to objects in their left visual field even though they were not blind. We then placed a vertical parasagittal mirror on each patients'' right so that they could clearly see the reflection of objects placed in the (neglected) visual field. When shown a candy or pen on their left, the patients kept banging their hand into the mirror or groped behind it attempting to grab the reflection; they did not reach for the real object on the left, even though they were mentally quite lucid and knew they were looking into a mirror. Remarkably, all four patients kept complaining that the object was ''in the mirror'', ''outside my reach'' or ''behind the mirror''. Thus, even the patients'' ability to make simple logical inferences about mirrors has been selectively warped to accommodate the strange new sensory world that they now inhabit. The finding may have implications for understanding how the brain creates representations of mirror reflections.     

铜绿假单胞菌注射液联合顺铂治疗消化道恶性腹腔积液的临床研究

目的：比较铜绿假单胞菌注射液联合顺铂与单纯使用顺铂治疗消化道恶性腹腔积液的疗效。方法：将250例消化道恶性中等量以上腹腔积液患者分为对照组和实验组各125例。所有患者行穿刺置管引流术,地塞米松预防发热,予盐酸利多卡因预防腹痛。铜绿假单胞菌注射液每周两次,顺铂每周一次,疗程一周,最多两个疗程。结果：实验组患者有效率为85．6％,其中,完全缓解40例,部分缓解67例。对照组例患者有效率为52％,其中,完全缓解24例,部分缓解4l例。两组比较差异有统计学意义（x2=32．87,P〈0．05）。实验组患者WHO体力状态评分（1分和2分）为104例,有效率为83．2％;对照组患者WHO体力状态评分（1分和2分）为72例,有效率为57．6％。两组比较差异有统计学意义（x2=19．67,P〈0．05）。结论：铜绿假单胞茵注射液联合顺铂腹腔内给药治疗消化道恶性腹腔积液。临床疗效显著。     

Monoclonal antibody production in murine ascites. I. Clinical and pathologic features

BACKGROUND AND PURPOSE: Murine ascites production has been associated with appreciable morbidity and mortality, thus raising animal-welfare concerns. To address these concerns, the clinicopathologic changes associated with in vivo production of monoclonal antibodies in mice were characterized, and results were compared among cell lines. METHODS: Five hybridoma cell lines were grown in groups of 20 mice. Fourteen days prior to inoculation with 10(6) hybridoma cells, mice were primed with 0.5 ml of pristane given intraperitoneally; 12 mice were sham treated (controls). Ascites fluid was collected a maximum of three times by abdominal paracentesis. Clinical observations and pre- and postabdominal tap body weights were recorded. Necropsies were performed on all mice. RESULTS: For all groups combined, overall survival to tap 1 was 98%, to tap 2 was 96%, and to tap 3 was 79%; survival among groups ranged from 90 to 100% for tap 1, 85 to 100% for tap 2, and 35 to 100% for tap 3. Disseminated intra-abdominal seeding with irregular soft tissue and/or solid tumor masses was observed at necropsy. CONCLUSIONS: Significant clinicopathologic changes were associated with monoclonal antibody production in mice, and differences between various hybridoma cell lines were apparent.     

锁骨下静脉穿刺置管术在神经外科重症患者的应用的临床效应 （附300 例病例报告）

目的:分析探讨锁骨下静脉穿刺置管术在重症神经外科疾病中的应用的临床效应。方法:选择锁骨下静脉,首选右侧,如果穿刺右侧失败改为左侧。穿刺成功后用扩张器扩皮,最后顺导丝置入导管,根据患者身高置管长度为12～15 cm,局部缝合固定,外敷纱布封闭或用一次性贴膜封闭。静脉留置管接三通静脉输液管。结果:286例首次穿刺右侧成功282例,4例失败后改选左侧成功。静脉导管留置时间最短3天,最长45天,留置时间平均为18天。结论:锁骨下静脉穿刺置管术在神经外科中抢救治疗重症患者是十分便利、有效的措施。锁骨下静脉穿刺置管术较其他深静脉穿刺置管如股静脉、颈内静脉和颈外静脉穿刺置管术及PICC相比较,更利于护理并具有费用低廉的优点。其方便、有效、经济的特点十分利于临床应用。     

彩色超声与盲探穿刺右颈内静脉并发症比较

目的比较彩色超声引导与盲探穿刺右侧颈内静脉置管术的并发症情况。方法将我院拟择期(在腹腔镜下)行结直肠肿瘤切除术的患者100例,ASA分级Ⅰ~Ⅲ级,年龄23~81岁,体重32~81kg。采用抛硬币法将患者随机分为彩色超声组(C)和盲探穿刺组(M)各50例。记录两组病人黑色细针试穿中静脉时次数、薄壁蓝空针穿刺中静脉时次数、穿刺点的数目、导管置入失败的次数,并记录病人由于穿刺引起的机械并发症及术后留置导管并发症情况。结果两组患者均未见明显机械并发症,且两组比较无统计学意义;两组无误穿动脉、血气胸及心律失常或心脏损伤的情况。结论彩色超声引导下行右颈内静脉穿刺成功率较盲探穿刺高,盲探穿刺刺破颈内静脉后壁概率较彩色多普勒超声引导下穿刺组高,其余机械并发症及留置中心静脉导管并发症比较无统计学意义。     

Three synchronous primary carcinomas in a patient with HNPCC associated with a novel germline mutation in MLH1: Case report

Background

Adnexal masses are not uncommon in patients with breast cancer. Breast cancer and ovarian malignancies are known to be associated. In patients with breast cancer and co-existing pleural effusions, ascites and adnexal masses, the probability of disseminated disease is high. Nevertheless, benign ovarian masses can mimic this clinical picture when they are associated with Meigs' syndrome making the work-up and management of these patients challenging. To our knowledge, there are no similar reports in the literature and therefore we present this case to highlight this entity.

Case presentation

A 56-year old woman presented with a 4 cm, grade 2, invasive ductal carcinoma of her left breast. Pre-treatment staging investigations showed a 13.5 cm mass in her left ovary, a small amount of ascites and a large right pleural effusion. Serum tumour markers showed a raised CA125 supporting the malignant nature of the ovarian mass. The cytology from the pleural effusion was indeterminate but thoracoscopic biopsy failed to show malignancy. The patient was strongly against mastectomy and she was commenced on neo-adjuvant Letrozole 2.5 mg daily with a view to perform breast conserving surgery. After a good response to the hormone manipulation, the patient had breast conserving surgery, axillary sampling and laparoscopic excision of the ovarian mass which was eventually found to be a benign ovarian fibroma.

Conclusion

Despite the high probability of disseminated malignancy when an ovarian mass associated with ascites if found in a patient with a breast cancer and pleural effusion, clinicians should be aware about rare benign syndromes, like Meigs', which may mimic a similar picture and mislead the diagnosis and management plan.     

Diagnosing and management of iatrogenic moderate and severe ovarian hyperstymulation syndrome (OHSS) in clinical material

Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART). The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function). Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications.     

Lateral hermaphroditism in a C3H mouse.

A spontaneous case of true lateral hermaphroditism was observed in one of approximately 1000 necropsies of 12-wk-old female C3Hf-Wg mice (a substrain of C3H/He). Both the right ovary and abdominal left testis were functional as evidenced by the presence of oocytes in graffian follicles and spermatocytes maturing on sertoli cells. Both gonads communicated, the ovary via an oviduct and normal right uterine horn and the testis via an epididymus and vas deferens, with a vagina which ended in a blind pouch and was filled with squamous debris.     

Technical Evaluation of a Naso-Ruminal Instrument for Collection of Ruminal Samples in Non-Fistulated Cows

The sampling method used is of great importance for the estimation of the microbial activity and biochemical status in ruminal fluid (Stöber & Tiefenbach 1958, Keindorf 1974, Behravesh 1984). Several methods have been used for sampling of ruminal fluid in non-fistulated animals (Sørensen & Schambye 1955, Perk 1958, Schultz & Hiepe 1958, Keindorf & Link 1971). However, the conventional methods of collecting ruminal fluid either by stomach tube (Thygesen probe with a filter ad modum Sørensen & Schambye (1955)), or through a puncture low in the left flank, do not produce representative samples comparable in quality or quantity to samples collected directly through a rumen fistula. The puncture methods usually produce a very small volume of material, and they often leave the cow with an inflammatory reaction in the flank. Many research workers have demonstrated contamination with saliva in samples drawn through a peroral stomach tube, resulting inter alia in a higher pH value than in samples collected through fistula (Dirksen 1970, Behravesh 1984). Since changes in the fermentative reactions of high-yielding cows are receiving much research emphasis today, it has been our aim to construct an instrument suitable for collecting single or continuous samples for diagnostic as well as research purposes, which are comparable in quality and quantity to samples obtained through a rumen fistula. The idea of making the naso-ruminal sampler was inspired by the construction of the COMET Naso-Reticular Instrument (Hekmati et al. 1985).     

肝硬化患者无菌腹水中真菌DNA的检测及易位研究

目的检测和分析肝硬化患者无菌腹水中真菌DNA存在状况。方法选取118例无菌腹水的肝硬化患者为研究对象,分别采集患者刚入院时的腹水、血液和粪便标本。应用PCR技术直接检测标本的真菌DNA并克隆测序。并收集患者临床资料,对患者临床症状及检验结果进行分析比较。结果1名患者的腹水、血液、粪便中同时检测到真菌DNA,14名患者的腹水和粪便中同时检测到真菌DNA,3名患者的血液和粪便中同时检测到真菌DNA,大部分序列间的相似性高于99％。测序检测到最多的菌种为Candidaalbicans。结论肝硬化患者无菌腹水中能够检测到真菌DNA,并且提示在肝硬化患者腹水和血清中检测到的真菌DNA易位于肠道。     

Laparoscopic ovariectomy in standing cows

The main objective of this study was to evaluate laparoscopic ovariectomy and to develop an optimal surgical technique for this procedure in standing cattle.

Eight cows underwent laparoscopic ovariectomy. In two cows, a bilateral flank approach was used and in six cows, both ovaries were removed via a left flank approach.

An important prerequisite for ensuring sufficient intrabdominal space for instrumentation, optimal endoscopic orientation and easy access to the ovaries and uterus was withholding feed for at least 36 h prior to surgery. The cows were sedated with xylazine and the portal sites infiltrated with lidocaine. The portal for the laparoscope was at the ventral angle of the left paralumbar fossa, approximately 10 cm cranioventral to the tuber coxae. The instruments were inserted through two portals approximately 20 cm and 30 cm ventral to the tuber coxae. After abdominal insufflation with carbon dioxide, the left ovary was grasped and local anesthetic was injected into the mesovarium and mesosalpinx. The mesovarium was transected using bipolar cauterization and the ovary removed through an extended instrument portal. The right ovary was removed in the same way. The incisions were closed with single interrupted absorbable sutures in the musculature and single interrupted non-absorbable sutures in the skin. The procedure lasted 120–150 min.

Bilateral laparoscopic ovariectomy via left flank approach in standing cows is feasible. This procedure involves special instrumentation, but is minimally invasive and allows optimal visualization of the ovaries and uterus.     

A new method for localizing the landmark of axillary vein and its application

BackgroundAxillary vein puncture is a popular puncture site for pacemaker implantation. However, due to the lacking of body surface markers, the current puncture method is too complicated and affect the popularization and application of axillary vein puncture. Here, we performed a new body surface landmark to make the blind axillary vein puncture simple and easy.MethodsThe study population included 30 patients referred for pacemaker implantation using axillary vein puncture. Digital subtraction angiography (DSA) was used to determine the direction and the surface landmarks of the axillary vein. Medial cusp of thoracic triangle and the coracoid process were directly touched with fingers. The puncture point was about 1 cm below the coracoid, and the needle tip pointed to the medial cusp of thoracic triangle with the angle of 30–60°.ResultsThere was little variation in distribution of axillary vein. The body surface landmark of the junction of the axillary vein and the subclavian vein is on the medial cusp of thoracic triangle. In these 30 patients, blind axillary vein puncture was successful obtained in all patients. There was no pneumothorax and inadvertent arterial puncture. The pacemaker lead wire was placed smoothly. Moreover, the pacemaker pocket was ideally positioned when cut along the puncture point.ConclusionsBlind axillary vein access using the body surface landmark of the thoracic triangle is an effective method for pacemaker implantation and can obvious avoid the complications usually observed with the traditional subclavian vein approach.     

Diagnostic Abdominal Paracentesis

Diagnostic abdominal paracentesis was performed in 43 patients in whom the diagnosis was uncertain. It was found to be particularly useful in abdominal pain resulting from trauma. In 12 patients the findings led to their being spared a laparotomy while in several other patients they led to very early diagnosis of the lesion responsible enabling early surgical treatment to be undertaken. A false-negative result was obtained in only one patient. It is concluded that diagnostic abdominal paracentesis is an extremely reliable diagnostic aid and can lead to improved surgical care of the patient with atypical acute abdominal pain.     

Cardiac abnormalities in liver cirrhosis.

Cirrhosis is associated with several circulatory abnormalities. A hyperkinetic circulation characterized by increased cardiac output and decreased arterial pressure and peripheral resistance is typical. Despite this hyperkinetic circulation, some patients with alcoholic cirrhosis have subclinical cardiomyopathy with evidence of abnormal ventricular function unmasked by physiologic or pharmacologic stress. Florid congestive alcoholic cardiomyopathy develops in a small percentage, but the concurrent presence of cirrhosis seems to retard the occurrence of overt heart failure. Even nonalcoholic cirrhosis may be associated with latent cardiomyopathy, although overt heart failure is not observed. Tense ascites is associated with some cardiac compromise, and removing or mobilizing ascitic fluid by paracentesis or peritoneovenous shunting results in short-term increases in cardiac output. Cirrhosis also appears to be associated with a decreased risk of major coronary atherosclerosis and an increased risk of bacterial endocarditis. Small hemodynamically insignificant pericardial effusions may be seen in ascitic patients. The release of atrial natriuretic peptide appears to be unimpaired in cirrhosis, although the kidney may be hyporesponsive to its natriuretic effects.     

Dolphin peripheral visual pathway in chronic unilateral ocular atrophy: Complete decussation apparent

Components of the peripheral visual pathway were examined in two bottlenose dolphins, Tursiops truncatus, each with unilateral ocular degeneration and scarring of 3 or more years' duration. In both animals, the optic nerve associated with the blind eye right eye in Tg419 and left eye in Tt038 had a translucent, gel-like appearance upon gross examination. This translucency was also evident in the optic tract contralateral to the affected eye. In Tg419, myelinated axons of varying diameters were apparent in the left optic nerve, whereas the right optic nerve, serving the blind eye, appeared to be devoid of axons. In Tt038, myelinated axons were associated with the right optic nerve (serving the functional eye) and left optic tract but were essentially absent in the left optic nerve and right optic tract. Examined by light microscopy in serial horizontal sections, the optic chiasm of Tt038 was arranged along its central plane in segregated, alternating pathways for the decussation of right and left optic nerve fibers. Ventral to this plane, the chiasm was comprised of fibers from the left optic nerve, whereas dorsal to the central plane, fibers derived from the right optic nerve. Because of this architectural arrangement, the right and left optic nerves grossly appeared to overlap as they crossed the optic chiasm with the right optic nerve coursing dorsally to the left optic nerve. At the light and electron microscopic levels, the optic nerves and tracts lacking axons were well vascularized and dominated by glial cell bodies and glial processes, an expression of the marked glial scarring associated with postinjury axonal degeneration. The apparent absence of axons in one of the optic tract pairs (right in Tt038 and left in Tg419) supports the concept of complete decussation of right and left optic nerve fibers at the optic chiasm in the bottlenose dolphin. © 1994 Wiley-Liss, Inc.     

Laparoscopic ovariectomy in standing cows

The main objective of this study was to evaluate laparoscopic ovariectomy and to develop an optimal surgical technique for this procedure in standing cattle.Eight cows underwent laparoscopic ovariectomy. In two cows, a bilateral flank approach was used and in six cows, both ovaries were removed via a left flank approach.An important prerequisite for ensuring sufficient intrabdominal space for instrumentation, optimal endoscopic orientation and easy access to the ovaries and uterus was withholding feed for at least 36 h prior to surgery. The cows were sedated with xylazine and the portal sites infiltrated with lidocaine. The portal for the laparoscope was at the ventral angle of the left paralumbar fossa, approximately 10 cm cranioventral to the tuber coxae. The instruments were inserted through two portals approximately 20 cm and 30 cm ventral to the tuber coxae. After abdominal insufflation with carbon dioxide, the left ovary was grasped and local anesthetic was injected into the mesovarium and mesosalpinx. The mesovarium was transected using bipolar cauterization and the ovary removed through an extended instrument portal. The right ovary was removed in the same way. The incisions were closed with single interrupted absorbable sutures in the musculature and single interrupted non-absorbable sutures in the skin. The procedure lasted 120–150 min.Bilateral laparoscopic ovariectomy via left flank approach in standing cows is feasible. This procedure involves special instrumentation, but is minimally invasive and allows optimal visualization of the ovaries and uterus.     

超声引导下穿刺置管引流治疗肝脓肿的疗效分析

目的:探讨超声引导下穿刺置管引流治疗肝脓肿的临床疗效。方法:回顾性分析本院2012-2013年56例肝脓肿住院患者超声引导下穿刺置管引流治疗的临床资料。结果:56例患者行超声引导下穿刺置管引流治疗,其中3例多发脓肿行2次穿刺置管治疗,其余均一次穿刺置管成功,未出现出血、胆漏、周围脏器损伤等并发症,本组患者手术前后体温、白细胞数及脓肿面积比较均有统计学意义(P0.01)。24例体温升高患者中,21例术后3天内恢复正常,3例仍有升高;41例白细胞数升高患者中,29例术后3天内恢复正常,12例仍有增高;56例患者术后脓肿面积均明显减小,该组患者腹痛、肝区叩痛等临床症状均明显缓解。结论:超声引导下穿刺抽吸及置管引流治疗肝脓肿是一种简单方便、安全可靠、创伤小、明显有效的局部治疗方法,操作者需要充分作好术前准备,严格把握适应症,严谨操作步骤并结合全身抗生素治疗可以明显改善患者发热症状,有效降低患者白细胞及中性粒细胞,明显缩短治疗周期,提高治愈率。